The embodiments of the present invention relate generally to tubing attachment mechanisms, and more particularly, to ergonomic tubing attachments for use in medical apparatus such as ultrasonic surgical aspirators.
Ultrasonic aspiration has become the standard of care for removal of tumors and diseased tissue in neurosurgery and general surgery. Ultrasonic aspirators are used for ultrasonic fragmentation of tissue at an operation site and aspiration of the tissue particles and fluid away from the site. Typically, ultrasonic surgical aspirators include an ultrasonic transducer supported within a handpiece, an ultrasonically vibrating horn or tip operably connected to the ultrasonic transducer, and a sleeve or flue positioned about the horn. The horn includes a longitudinally extending central bore having one end located adjacent a distal tip and a second end located adjacent the proximal end of the horn. The proximal end of the horn is adapted to engage a vacuum source to facilitate aspiration of fluid. The flue is positioned about the horn to define an annular passage. Irrigation fluid is supplied through the annular passage around the horn to the surgical site where it mixes with blood and tissue particles and is aspirated through the bore in the horn. By mixing the irrigation fluid with the blood and tissue particles, coagulation of the blood is slowed down and aspiration thereof is aided. When the longitudinally vibrating tip in such an aspirator is brought into contact with tissue, it gently, selectively, and precisely fragments and removes the tissue. U.S. Pat. Nos. 5,015,227 and 4,988,334 disclose such ultrasonic surgical devices and are incorporated herein by reference. A known ultrasonic aspirator on the market is the CUSA EXcel® Ultrasonic Surgical Aspirator (Integra LifeSciences Corporation, Plainsboro, N.J., U.S.A.).
Surgeons frequently need to use surgical instruments, such as handpieces in ultrasonic aspirator systems, for long periods of time while maintaining dexterity. A “pencil-grip” is often employed for precise handling. This style of gripping a long thin object is also known as the “dynamic tripod grip” in the biomechanics literature. During precise manipulation of the instrument, a complex set of antagonistic muscles are employed in the human hand to control shaking and maintain the desired trajectory of the surgical instrument.
The energy stored in twisting an elastomeric tube can be quite large. For example, a toy aircraft can be powered by the energy stored in the twist of an elastic band for up to several minutes on a single winding. In the case of the surgical handpiece, due to the length of the tubing going from the handpiece to the instrument console or wall vacuum outlet, the elastic energy stored in the tubing can be large even for small twist angles. Also, as the tubing is handed over from the assistant to the surgeon or between multiple surgeons operating simultaneously, the tubing can get progressively wound up requiring the surgeon to provide more and more opposing force to keep the tool tip from rotating. If a dynamic mechanism to alleviate the torque is not provided, the ergonomic situation can get progressively worse. The length of tubing that is not directly used can be coiled and placed in the vicinity of the surgical field. The act of coiling and uncoiling can also build up twist.
In recent years, the surgical community has gradually moved from open surgery to laparoscopic surgery (also known as Minimally Invasive Surgery or MIS) for certain surgical procedures. In this modality of surgery, the grip style of surgical instruments is slightly different—it is more like grasping a screwdriver, rather than a pencil-like grip. In this style of grip, the rotation or torque of the instrument is even more prominent than in the pencil-like grip.
The fact that ergonomics of existing instruments are poor has been documented by surgeons. For example, Berguer et al. have observed that surgeons reported increased upper-extremity fatigue and occasional hand numbness after laparoscopic procedures (Surgical Endoscopy (1999) 13: 466-468). Franasiak and Gehrig have reported that recent data on MIS surgeons indicate very high rates of surgeon strain, 88% when robotic assistance is not used, and identify instrument design as a major concern (J. of Clinical Outcomes Management (2015) 22(6): 267-273).
There are many different parameters that confound the factors that can be studied in attempting to design surgical instruments and tubing attachments to alleviate surgeon fatigue in prolonged use. Attempts have been made, for example, by reducing the stiffness of the tubing while maintaining non-kinkability, or by keeping the flexibility of the tubing while keeping the stiffness high.
U.S. Pat. No. 8,211,103 discloses an electrosurgical instrument with an adjustable power cable. The electrosurgical instrument includes a hand piece that is connected to an electrosurgical generator by way of an electrical cable. The hand piece includes a channel system that receives a portion of the electrical cable therein and allows a physician to adjust the location on the hand piece at which the electrical cable exits the hand piece.
U.S. Patent Application Publication No. 2008/0200884A1 describes an ophthalmic surgical instrument that includes a reinforcement structure, such as ribs, on the outer surface of the irrigation tubing to resist kinking of the tubing during surgery.
However, prior art does not recognize that a significant portion of the fatigue is due to the rotational twist of the tubing. Prior art has failed to identify this major factor associated with surgical instruments that adds to the surgeon fatigue problem and has not provided satisfactory solutions.
Hence, those skilled in the art have recognized a need for ergonomic surgical instruments that alleviate surgeon fatigue in prolonged use. The embodiments of the present invention fulfill this need and others.